Table 4 Medications for orthostatic intolerance and their permissibility in competitive swimming
Medication | Comments | Allowed in swimming? |
|---|---|---|
Vasoconstrictors | ||
 Midodrine | Suggested as first line therapy for those with baseline hypotension | Yes, outside of competition; in competition requires a TUE |
 Stimulants  Methylphenidate, dextroamphetamine, and others | Suggested as first line therapy for those with prominent cognitive dysfunction or a personal or family history of attention deficit hyperactivity disorder | Yes, outside of competition; in competition requires a TUE |
Volume expanders | ||
 Sodium chloride | Oral supplements not always sufficient as the only therapy. IV normal saline is impractical over the longer term, but can help restore baseline function after acute infections or as rescue therapy | Yes for oral sodium For IV fluids > 100 mL, a TUE is required |
 Fludrocortisone | Suggested as first line therapy for those with baseline hypotension or increased salt appetite. Potassium supplementation is needed due to increased urinary potassium excretion. Can aggravate acne | Yes, outside of competition; in competition requires a TUE |
 Hormonal contraceptives | Indicated for females with dysmenorrhea or when fatigue and lightheadedness worsen with menses | Yes |
 Desmopressin acetate | Suggested for those with nocturia. Hyponatremia can occur | No; requires TUE in and out of competition |
Sympathetic tone and heart rate modifiers | ||
 Beta adrenergic antagonists  Atenolol, propranolol | Suggested as first line therapy for those with a relatively elevated resting heart rate, anxiety, or headache. Can exacerbate asthma. Contraindicated for diabetics | Yes |
 Pyridostigmine bromide | Effective in POTS and neurally mediated hypotension. Also helpful for GI motility problems | Yes |
 Clonidine | Suggested for those with anxiety, problems with attention, or insomnia | Yes |
 Ivabradine | Suggested for those with elevated baseline heart rate | Yes |
SSRI/SNRI | ||
 Escitalopram, sertraline | Indicated for dysthymia, depression, or anxiety | Yes |
 Duloxetine | Useful if myalgias are prominent | Yes |